Credentialing

Provider Credentialing

Credentialing is an important step for any physician who is new to Kids Health First. The process for completing the physician membership application packet is very lengthy and dependent upon receipt from you of the detailed information required by Kids Health First and the insurance companies. If all documents are in order, it will typically take Kids Health First approximately 45 to 60 days to credential a new physician. It will generally take an additional 60-90 days for a Payor to input the new physician into its system. Again, all documents need to be complete at submission. Please be sure to follow all directions noted on each of the applicable forms which are listed below. Any missing information or missing supporting documents can delay the process:

• Georgia Uniform Healthcare Practitioner Credentialing Application

Required for Peach State Medicaid CMO

• Physician Participation Attestation

For Practices that take Medicaid, please be sure to fill out the state Medicaid application for your new physician as soon as possible. For a physician that does not currently have a state of Georgia Medicaid number it can take up to 6 months to get this. The Kids Health First Medicaid Payors will NOT accept any data for your new physician until we can furnish them with this number.

For more provider credentialing information or questions, please contact us at credentialing@khfirst.com or contact Patsy Chastain at pchastain@khfirst.com or call (678) 457-9615.

 

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Mid-Level Credentialing

Please note that Kids Health First does not credential mid-level providers but can assist with adding them to the payor contracts.

Mid-Level Information Packet

The purpose of the Mid-Level Information Packet is to collect necessary information to attach mid-level provider to the Kids Health First Medicaid Agreements.  Kids Health First does NOT credential Nurse Practitioners or Physicians Assistants.

Medicaid payors:

For Medicaid payors, mid-level providers must credential with the Department of Community Health’s (DCH) Credentialing Verification Organization (CVO) via the GAMMIS website.

• Enrollment instructions and documents can be found here.

Kids Health First submits mid-level provider information to Medicaid payors CareSource and Peach State Health Plans as a courtesy to our practices.  Once mid-level providers have approved credentialing AND an active Medicaid ID for their new/current practice, the documents in this packet can be completed and submitted to credentialing@khfirst.com, attn: Patsy Chastain.

• Mid-Level Information Form
• IRS W‐9 Form
• Pre-Hire Screening must be completed and approved (if in KHF Malpractice Program) before completing packet.

Please retain a copy of all completed documents for your records. 

Commercial payors:

For commercial payors, Kids Health First does NOT contract mid-levels.  They must contract directly and submit their own data updates.  This informational packet does not apply to commercial payors.

For questions regarding mid-level credentialing, please contact Patsy Chastain at (770) 333–0033, Ext. 207.